Political expedience, a touchy
language debate and a long-standing rivalry between
two cities have all come crashing to a head in New Brunswick.
The government is currently mulling over a site for
a proposed provincial tertiary trauma centre. At stake
is a whole lot of infrastructure and technology cash,
not to mention a nice helping of prestige. Three hospitals
— two in Moncton and one in Saint John — are
engaging in some high-level lobbying to become trauma
central.
The debate can be traced back to
a very high profile trauma care blunder in 2005 that
nearly cost a man his life. Donald Thomas, 67, from
Tracadie in the heart of New Brunswick's Acadian north,
was on his way to nearby Lameque to take some fruit
to his hospitalized wife when he was involved in a serious
head-on collision. Despite his critical status, he was
forced to wait 18 hours for surgery while the trauma
team figured out what to do with him. The drama that
was to unfold would have wide-ranging implications for
how trauma services are delivered in the province.
PATIENT
PING-PONG
Tracadie's small community hospital didn't have the
facilities to deal with such a case; doctors in larger
Moncton, 200km away, refused to take him, advising he
be sent to Bathurst instead. Mr Thomas languished there
for 12 hours with very severe injuries. He was nearly
sent to Halifax (460km away) because his doctor, a Quebecer
who was new to NB, wasn't aware that Saint John even
existed (the city is often confused with St John's,
Newfoundland) let alone had an accredited trauma centre.
Luckily for Mr Thomas, when they called Halifax to arrange
transfer an incredulous hospital staffer there said
"Take him to Saint John!" (370km away). He was eventually
transferred there and operated on.
Mr Thomas went public with his
harrowing ordeal and then-health minister Elvy Robichaid
commissioned a report into what went wrong. The report
— details of which were released in April 2006
— by Dr Isser Dubinsky, a veteran Toronto-based
healthcare consultant, contained a whole lot of criticism
about the way trauma care was being handled in the province
— and some 29 recommendations. Among them, Dr Dubinsky
recommended a dedicated trauma centre (the cause of
the current debate), more personnel devoted solely to
trauma and better air ambulance service.
TALE
OF TWO CITIES
Saint John, the largest city in the province, has been
in decline for decades but currently has the only accredited
trauma centre in the province. Moncton, the province's
second city, is growing rapidly. Some cynics say its
most attractive attribute is that it's new health minister
Michael Murphy's political riding.
Dr Dubinsky was again drafted to
produce a report comparing the merits of the two potential
sites. His report is due for release in the near future.
In the meantime, Dr Andrew Trenholm, surgical director
of the Saint John Regional Hospital (SJRH), wonders
why there's any question at all. For this Moncton-bred
orthopedic surgeon — the very surgeon who operated
on Mr Thomas — the Port City is the only sensible
choice. "I chose to come to Saint John because of its
nationally accredited trauma centre so I don't understand
how this debate even started," he says. "It's not like
they can take our accreditation away from us."
Yet the debate has started and
some doctors at Moncton's two hospitals are eagerly
promoting the virtues of their facilities (even though
they refused Mr Thomas). "We are bilingual from wall
to wall," Beauséjour Health Authority CEO Dr
Louis Simard told the Telegraph-Journal. He also
added that Moncton is a more central location than Saint
John, and that the city's two hospitals would eagerly
share resources and specialist expertise (one of the
big strikes against Dumont Hospital is that it doesn't
have an on-call neurology department). Dr Daniel de
Yturralde, medical director for Beauséjour, is
also pushing for his city to get the trauma nod. He
told the Times and Transcript "It's location
Number One. This is the hub." (Moncton's nickname is
"Hub city.")
A
REAL TRAUMA
Dr Trenholm has been given permission to discuss his
former patient's case, and has fleshed out many of the
details from that fateful night. He describes the sorry
state Mr Thomas was in when he arrived: "He had a whole
paragraph of injuries. A closed head injury, a broken
neck, multiple broken ribs on both sides of his chest,
a broken breast bone, a cardiac contusion, a collapsed
lung, a liver laceration, both hips were broken, both
thigh bones shattered, right knee cap broken, right
ankle broken and dislocated out of joint, and lastly
a broken right upper arm."
"I think the government fails to
understand that you really need to have a provincial
trauma programme," Dr Trenholm adds. "I'd really like
to see Saint John take the lead in developing such a
program, one that would be inclusive, incorporating
Fredericton, Moncton, the Miramichi and Bathurst."
He adds, "The government thinks
that if they designate one trauma centre — say
Saint John — that it means that if you're in an
accident outside the doors of the Moncton City hospital
that they're going to put you in an ambulance and send
you to Saint John. Medically that's just dumb."
For Dr Trenholm, creating a hotline
would be the cheapest and easiest way to get the ball
rolling on a provincial trauma network. He envisions
a 1-800 trauma number, available to every doctor in
the province. The hotline calls would be routed to on-call
trauma doctors at the SJRH, and prevent another case
like Mr Thomas's. These trauma specialists could then
"traffic direct" — advising a doctor who phones
in where is the most appropriate facility to send the
patient.
The health minister agrees there's
a problem. "The lack of an on-call list within even
a loose trauma system in the province is completely
unsatisfactory and unacceptable," said Minister Murphy.
"That is one of the very basic things that we have to
have." Dr Dubinsky's new report is also to include recommendations
on on-call rosters. If money were no object, Dr Trenholm
would also like to see improved helicopter service —
SJRH, he points out, already has a heliport.
TONGUE
TIED
As Canada's only officially bilingual province, nearly
all political debates in New Brunswick touch upon the
language issue. Some have argued that Saint John, a
primarily English-speaking city, is a less appropriate
site for a province-wide trauma centre than bilingual
Moncton. Dr Trenholm dismisses this out of hand. "It's
a non-issue," he says. "The Medical Services Act of
New Brunswick states that you have to be able to offer
treatment in both official languages in any hospital
and I would say we do an extremely good job at this
here in Saint John." He says his former patient Mr Thomas,
a francophone, would attest to that. In fact, Mr Thomas,
who lives considerably closer to Moncton, is so passionately
advocating that the SJRH be named the provincial trauma
centre that he's threatened to sue the province if they
decide otherwise. "I think it should be Saint John because
of the spirit in which the Saint John Regional Hospital
was instituted," he told the Telegraph-Journal.
The government's decision could
deeply affect doctors in the province, predicts Dr Trenholm.
"It would change provincial referral patterns, it may
lead to physicians leaving the province or having to
change where they work," he says. "A lot of the recruitment
we've done at the Saint John Regional Hospital over
the last 10 years were for extra specialists to work
in the trauma centre."
The health minister maintains that
no-one wants to take the trauma facilities away from
Saint John. "There is no one on the grassy knoll looking
to knock off certain regional hospital authorities,"
he said in the legislature recently.
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